Plastic and Reconstructive Surgery

Welcome

Dr. Julie Vasile is an ABPS board certified plastic and reconstructive surgeon practicing in Westchester County, New York, Fairfield County, Connecticut, and New York City. Dr. Vasile has a special interest in restoring the form and self-confidence of patients with breast cancer. She believes her patients deserve to be informed of their options to enable them to make educated decisions. Dr. Vasile will listen compassionately to you and guide you.

Perforator Flap Microsurgical Breast Reconstruction (NO MUSCLE used)

Dr. Julie Vasile specializes in perforator flap breast reconstruction, a technique that uses your own fat and skin tissue to create a breast, without harming the muscle. The tissue can be transferred from many donor sites on the body, but the abdomen is the most common source of tissue.

When the abdomen is the source of tissue, the procedure is commonly referred to as a DIEP(deep inferior epigastric artery perforator) flap or SIEA(superficial inferior epigastric artery perforator) flap.

There are continuous advancements in knowledge resulting in more areas of fatty tissue that a breast can be reconstructed from. Dr. Vasile continues to keep abreast of surgical advancements so that patients have reconstructive options.

Dr. Julie Vasile performs this surgery as a team with another microsurgeon, who has also done additional extensive fellowship training with perforator flap breast reconstruction. We have treated many patients that thought they had no further options.

Research and Innovation

Dr. Julie Vasile is considered a world authority on using MRA imaging for perforator flap breast reconstruction. Dr. Vasile's research created protocols for using magnetic resonance angiography (MRA) to accurately map out the small vessels in the tissue (abdomen, buttock, thigh, and lateral thorax), thus identifying the best vessel and site to use for microsurgical breast reconstruction.

She started the first MRA perforator flap program that accurately and simultaneously mapped out non-abdominal and abdominal tissue with radiologist Dr. Prince in 2008.

Advance knowledge of the best vessel to use can help the surgeon identify suitable patients for perforator flap breast reconstruction and can shorten the operating time. In contrast with other imaging modalities, MRA does not expose patients to radiation. This continuing research collaboration is an effort to improve efficiency and safety for the procedure.

The most useful recent advance in perforator flap reconstruction is stacked flaps, also called double flaps, to make one breast. Dr. Vasile has tremendous and successful experience with stacked DIEP flaps for reconstruction of one breast to match the other breast. The newest advance in stacked flaps is using double flaps to make two breasts or four flap breast reconstruction.

An extended DIEP flap or 4 flap procedure uses the standard DIEP flap along with the fat on the sides of the abdomen (DCIP flap). It allows the creation of two breasts using the abdominal fat and sides of the abdomen to meet reconstruction volume and tissue requirements. This is a technically more complicated procedure, but can reliably provide adequate volume in one stage.

The world's first6 flap procedure that used the front, sides, and lower back fat was done at Northern Westchester Hospital in February 2017 to successfully yield enough tissue for reconstruction of two breasts in a very thin woman. The world's second 6 flap procedure was done in March 2017.

Double flaps and multiple flaps can be a powerful reconstruction tool in the right patient. Double flaps simultaneously from the abdomen and thigh donor site or from two thighs are potential options that have yielded tissue in our breast reconstruction patients who thought they had no further options.

Preoperative MRA information, attention to details, minimizing risk with a thorough preoperative consultation, nursing team dedicated to breast flap reconstruction, two surgeon team of which each surgeon is fellowship trained specifically in perforator flap breast reconstruction are some of the factors that has led to her excellent patient outcomes.

Successful Outcomes

Dr. Julie Vasile started the perforator flap breast reconstruction program at Northern Westchester Hospital, Mt. Kisco, NY in 2011. From 2011 to 2017, she has a 0.5% flap fail rate in Westchester, NY.

An interest of Dr Vasile’s is in lymph node transfer for the possible improvement in lymphedema (arm swelling after axillary node dissection or congenital leg swelling). The lymph node transfer can be done in conjunction with a deep inferior epigastric artery perforator (DIEP) or superficial inferior epigastric artery (SIEA) flap procedure for breast reconstruction. A lymph node flap can also be transferred microsurgically on its own blood supply to the site of lymphedema.